Preliminary evaluation of day-care percutaneous nephrolithotomy / 中华泌尿外科杂志

ABSTRACT

Objective:To investigate the safety and feasibility of day-care percutaneous nephrolithotomy (day-PCNL).Methods:The records of 46 consecutive patients underwent PCNL procedures for renal calculus from October 2017 to June 2019 at our institution were analyzed retrospectively. Their mean age was (46.7±8.5) years. Of all the 46 patients, 31 were males and 15 were females. Average BMI was (22.7±2.1) kg/m 2, with 37 cases of ASA scoreⅠ and 9 cases of score Ⅱ. Among the 46 patients, there were 27 cases of pelvis stones and 19 cases of upper ureteral stones, and 27 cases on the left side and 19 cases on the right side, with the maximum stone diameter of(2.31±0.52)cm. Patients underwent a clear diagnosis and surgical planning in the outpatient clinic, and the relevant preoperative examination, anesthesia evaluation and operative appointment. were completed. Patients came to the hospital at 9 o'clock on the day of operation, and underwent operation immediately after preoperative preparation. Under the paravertebral anesthesia, the F5 ureteral catheter was placed under the cystoscope in the lithotomy position, then the patients were placed in the prone position for percutaneous tract dilation. The F18 tract was established under the ultrasound guidance. Lithotripsy was performed by using F9.8 ureteroscopy and holmium laser. After an overnight observation, the patients were discharged when reaching the criteria including normal voiding, movement recovery, no fever or pain, no severe hematuria, no dizziness or headache, no cough, no nausea or vomiting, and answer fluently. The operative duration, perioperative complications, postoperative pain score (VAS score), and stone free rate at the first month were recorded. Results:All patients underwent successfully operations. Three individuals required full admission (longer than 24 h) due to pyonephrosis or postoperative fever, and the other 43 were discharged within 24 hours. Only one F18 tract was established for all patients, and the average operation time was (32.2±14.8)min. No pain was reported during the operation. The hemoglobin drop was (12.6±14.7)g/L, and no severe hemorrhage or transfusion occurred. The VAS pain score was (28.7±10.2) within 4 hours after the operation and (36.2±11.5) on the next morning. Stone free rate at 1 month was 95.3%. During 3 months follow-up period, no serious complication such as ureteral stricture, urinary leakage, or septic shock occurred.Conclusion:The day-care PCNL is safe and effective in appropriately selected patients, including single renal stone or upper ureteral stone less than 3cm.